Abstract
Abstract Content - 'The number of patients being diagnosed with Heart Failure (HF) on a global scale continues to rise, placing a huge strain on the National Health Service (NHS). Caring for patients with HF comes with huge cost implications and exacerbates an already growing economic burden for healthcare systems. HF care needs to be standardised and integrated if we are to provide optimal care. Evidence shows that there is potential to improve the detection, diagnosis and management of HF care through innovative care pathways when delivered consistently through strong leadership and collaborative working. A care pathway for clinical nurse assessors was developed and implemented to guide and steer HF care within an 'Out of Hospital' clinical team; create a streamlined process to move patients with HF from one service to another; and encourage collaborative working amongst HF services. In addition, weekly HF MDT meetings were introduced in an attempt to reduce hospital admissions.
The Model for Improvement Framework was used to provide structure and support the change management, along with the RE-AIM Framework which facilitated the implementation of this pathway and supported the translation of this project into practice.
Following the introduction of the care pathway, comparative data was analysed and the results showed that first line steps in the diagnostic pathway were being carried out quicker in patients presenting with HF symptoms, the time taken to refer on to cardiology services was significantly quicker, and all patients presenting with HF symptoms had a BNP blood test carried out on initial assessment. In addition, the length of time patients remained on the 'Out of Hospital' caseload and the number of hospital admissions were significantly reduced. The results also showed that the majority of patients on the pathway were treated in the comfort of their own homes and the number of patients referred to cardiac rehabilitation had vastly improved.
To conclude - integrated care pathways together with high level government strategies are vital in the re-organisation of HF care and the standardisation of interconnected guideline-based care and management. Implementing a HF care pathway not only streamlined care for patients diagnosed with HF within the community setting but it had a positive impact on patient outcomes, quality of life and hospital admission rates. The pathway provided clinical nurse assessors within the 'Out of Hospital' team with a structured and standardised approach to HF care and having regular HF MDT meetings significantly improved the outcomes of people living with HF, as complex cases could be managed quicker and more effectively and hospital admissions could be avoided. Communication channels and relationship building between specialist services were also enhanced as a result of the pathway.